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Second Opinion

Washington Highlights

CMS Does Not Finalize MA Plan Proposal to Modify Star Rating for Low Income Populations

April 10, 2015—The Centers for Medicare and Medicaid Services (CMS) April 6 released a final call letter outlining methodological changes to calendar year (CY) 2016 Medicare Advantage (MA) capitation rates. CMS did not finalize its proposal to adjust the weights of measures to account for MA plans that serve large populations of disadvantaged patients.

The agency had originally proposed to reduce the weight by 50 percent for seven measures where performance was associated with low income or dual status. The AAMC commented in support of the changes.

In explaining its decision, CMS cited concerns from commenters that the “proposed change [was] premature” and that the adjustment “diminishes the importance of clinical quality measures and has the potential to reward plans without improving care.” In its comments, the AAMC noted that “well-intentioned quality improvement programs must be fairly risk adjusted to ensure that they inspire care improvement rather than potentially dissuading plans and providers from caring for the most vulnerable.”

Inclusion of sociodemographic status (SDS) adjustments in quality performance programs has been a widely discussed topic. The National Quality Forum (NQF) is currently running a trial period to determine the impact of adjusting for SDS for certain measures. The AAMC has previously commented that measures undergoing the trial period should not be used for reporting or payment purposes, and should not be considered for a star ratings display on Hospital Compare [see Washington Highlights, Feb. 27]